Gianturco self-expanding stents: Clinical experience in the vena cava and large veins

Abstract

Twenty-five patients with stenosis of the vena cava (21) and other large veins (4) have been treated with self-expanding Gianturco metallic stents. Eighteen patients had superior vena cava syndrome. In 17, the stricture was due to malignant superior vena cava compression recurrent after maximum tolerance radiotherapy and/or chemotherapy. In 16 of these patients there was early symptomatic relief. In 1 patient with a benign posttraumatic superior vena cava stricture, the stenosis was not relieved, and occlusion occurred after 1 month. Stenoses associated with dialysis shunts were relieved in 2 other patients. Two malignant and one benign inferior vena cava stenoses were relieved either until death, or in the benign case, for 30 months. One malignant subclavian vein obstruction occluded after 24 h due to stent misplacement and another with extrinsic mediastinal compression remained patent until death, extensive thrombus having been lysed prior to stent placement. The results of this short series suggest that the Gianturco self-expanding stent in the vena cava and large veins is easy and safe to place, and in most cases produces almost immediate palliation of the distressing effects of venous obstruction, often in a preterminal and inoperable patient.

Results of Treatment of Inferior Vena Cava Syndrome With Expandable Metallic Stents

“…Others [2][3][4][5] documented that patency and initial technical success can be achieved in major venous obstruction with the placement of self-expanding, metallic stents. This article updates our experience in the diagnosis and treatment of IVC syndrome and evaluates the results of treatment with expandable metallic stents.…”

Vascular Stenting for Palliation of Superior Vena cava Obstruction in Non-Small-Cell Lung Cancer Patients: A Future ‘Standard’ Procedure?

“…Palliative treatment of SVCO uses radiotherapy and/or chemotherapy leading to a 59.8% overall response rate [22], while vascular stenting allows relief of symptoms in 85 to 100% of cases [6, 8, 10, 11, 14, 21, 26, 27]. Comparison with previously reported results is quite difficult because of patient’s heterogeneity (especially the presence of nonmalignant SVCO [24]or a large number of SCLC patients [15]better responding to radiotherapy or chemotherapy) and the lack of a worldwide accepted scale for scoring SVCO.…”

“…The first stent was implanted by Charnsangavej et al [4]in 1986 with encouraging results in 1 patient with SVCO. Since the early 90s, stent placement was used especially after failure of the first-choice treatment (radiotherapy and/or chemotherapy) [6, 8, 10, 11, 14, 21, 26, 27]. In few cases, the time of vascular stenting is not clearly known [16, 23].…”

Superior Vena Cava Syndrome. From the Bronchus to the Vessel

“…Oudkerk [33,57]; in non-small cell lung cancer response rates of radiotherapy are reported to be between 65% and 90% within three weeks [4,17]. On the other hand stent implantation is an easy and relatively safe procedure in the hand of an experienced specialist, it gives immediate relief of SVCS symptoms, which is important in patients with limited life expectancy; furthermore it does not interfere at all with any subsequent therapy [34].…”

“…Benign causes include tuberculous mediastinitis, syphilitic aortic aneurysms, mediastinal fibrosis, post-irradiation fibrosis, posttraumatic strictures, and intrathoracic goiter [14][15][16][17][18]. Iatrogenic causes for SVCS like catheter manipulations, pacemaker wire implantation, and aortic valve replacement must also be taken into consideration [19][20][21].…”